Generic (Fionernone) LUCIFINE

Finerenone is a medication used to reduce the risk of kidney function decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure in adults with chronic kidney disease associated with type 2 diabetes.Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA). It is taken orally (swallowed by mouth).

Chronic Kidney Disease

Indicated to reduce risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with chronic kidney disease (CKD) associated with type 2 diabetes

Starting dose

• Determine starting dose by eGFR (mL/min/1.73m²)
• eGFR ≥60: 20 mg PO qDay
• eGFR 25-60: 10 mg PO qDay
• eGFR <25: Not recommended
• Increase dosage after 4 weeks to the target dose of 20 mg qDay based on eGFR and serum potassium thresholds

Dosage Modifications

Dose adjustment

Dose adjustment based on current serum potassium concentration (mEq/L) and current dose

• Currently taking 10 mg qDay

  • ≤4.8 mEq/L: Increase dose to 20 mg qDay; if eGFR has decreased by more than 30% compared to previous measurement, maintain 10 mg dose
  • >4.8-5.5 mEq/L: Maintain 10 mg/day
  • >5.5 mEq/L: Withhold dose; consider restarting at 10 mg qDay when potassium ≤5 mEq/L

• Currently taking 20 mg qDay

  • ≤4.8 mEq/L: Maintain 20 mg qDay
  • >4.8-5.5 mEq/L: Maintain 20 mg/day
  • >5.5 mEq/L: Withhold dose; restart at 10 mg qDay when potassium ≤5 mEq/L

Renal impairment

• eGFR 15 to <90 mL/min/1.73 m²: No clinically relevant differences in AUC or peak plasma concentration
• Initial dose and adjustments are based on eGFR and serum potassium levels

Hepatic impairment

• Mild or moderate (Child-Pugh A or B): No dosage adjustment recommended
• Severe (Child-Pugh C): Avoid

Dosing Considerations

Monitoring

• Determine initial dose by measuring serum potassium levels and eGFR
• Do not initiate if serum potassium is >5 mEq/L
• If serum potassium is 4.8-5 mEq/L, may initiate with additional serum potassium monitoring within the first 4 weeks
• Measure serum potassium 4 weeks after initiating treatment, after dosage adjustments, and throughout treatment; adjust dose if needed